Factors in Gestational Diabetes Mellitus Predicting the Needs for Insulin Therapy.

Ya Zhang,Xianming Xu,Feifei Li,Jiashen Shao

doi:10.1155/2016/4858976

Ya Zhang, Xianming Xu + Show 2 more

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https://doi.org/10.1155/2016/4858976

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Abstract

Objective. To identify factors predicting the need for insulin therapy in pregnancies complicated by gestational diabetes mellitus (GDM). Methods. A total of 1352 patients with GDM diagnosed by the 75-g/2-h oral glucose tolerance test (OGTT) were enrolled in this study. Univariate and multivariate analysis were performed; receiver operating characteristics (ROC) were also drawn. Results. There was a significant difference in factors such as maternal age, pregestational BMI, first visit SBP, first visit DBP, FBG of first visit, FBG at time of OGTT, 75-g OGTT glucose value (fasting, after 1 h and 2 h), and serum HbA1c level at diagnosis between patients with insulin therapy and patients with medical nutrition therapy (MNT) alone. Multivariate analysis showed that higher FBG at time of OGTT, first 75 g OGTT 2 h plasma glucose, and HbA1c concentration at diagnosis lead to more likely need of insulin therapy. Conclusion. The probability of insulin therapy can be estimated in pregnant women with GDM based on fasting and 2 h glucose values during OGTT and HbA1c value at diagnosis of GDM.

Highlights

Gestational diabetes mellitus (GDM) is a carbohydrate metabolism disorder with onset or first recognition as early as during pregnancy [1]
Studies have demonstrated that some factors are underlying the requirement of insulin therapy for glycemic control in pregnancies complicated by gestational diabetes mellitus (GDM), such as diagnosis of GDM at an early gestational age, obesity, family history of diabetes, exacerbated fetal growth, fasting glucose levels, the values of the abnormal blood glucose level of 75 g oral glucose tolerance tests (OGTT), and the value of glycated hemoglobin [2]
Factors such as maternal age, pregestational BMI, first visit SBP, first visit DBP, FBG of first visit, FBG at time of OGTT, 75-g OGTT glucose value (1 h and 2 h during the test), and serum HbA1c level at diagnosis exhibited a significant difference between the two groups (P < 0.05)

Summary

Introduction

Gestational diabetes mellitus (GDM) is a carbohydrate metabolism disorder with onset or first recognition as early as during pregnancy [1]. Medical nutrition therapy (MNT) and exercise are the mainstay of treatment for GDM, but if this fails, antenatal insulin treatment (AIT) is needed to reduce glucose levels in order to ensure normal fetal development and better perinatal outcomes [2]. Studies have demonstrated that some factors are underlying the requirement of insulin therapy for glycemic control in pregnancies complicated by GDM, such as diagnosis of GDM at an early gestational age, obesity, family history of diabetes, exacerbated fetal growth, fasting glucose levels, the values of the abnormal blood glucose level of 75 g oral glucose tolerance tests (OGTT), and the value of glycated hemoglobin [2]

Methods

Results

Conclusion